It's Winter, so let's board some patients!
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General clinical
It's Winter, so let's board some patients!
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So today I have 25 patients boarding in other wards, on top of the patients in my own ward. So, before November, it's Winter. In our hosptial we don't have a winter ward to accommodate the inevi
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Forums » Open clinical » General clinical » It's Winter, so let's board some patients!
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It's Winter, so let's board some patients!
posted at 30/10/2012 9:25 PM GMT
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
So today I have 25 patients boarding in other wards, on top of the patients in my own ward. So, before November, it's Winter. In our hosptial we don't have a winter ward to accommodate the inevitable surplus of patients. We run at 95% occupancy throughout the Summer, so the excess has to be boarded on other wards. As the medical wards are also full, our patients end up on ortho, surgical, dermatology, gynae, ENT wards, or wherever there's a bed. We don't have a Winter ward. If we did, we could move blocks of patients, and nurses, and doctors to look after these patients efficiently. But we don't so we spend time walking a tour of the hospital to see patients in ones and twos. Why don't we have a Winter ward? Do you have one?
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Re: It's Winter, so let's board some patients!
posted at 31/10/2012 9:15 AM GMT
on bmj.com
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Posts: 1264
First: 13/4/2010 Last: 20/5/2013 |
The simple problem is a lack of capacity. Many years ago I was working in the old Royal Infirmary in Edinburgh when a new hospital was being planned. Subsequently I was speaking with a senior manager as I heard a number of complaints from docs and nurses that the new hospital didn't have enough beds. The manager looked me staright in the face and said "We've anlaysed bed occupancy rates and average occupancy is less than 80% so we don't need all the beds we have now". I looked her in the face and said "Yes, average occupancy is 80% but sometimes it is 70% and sometimes it's 110%. Even if it was always 80% it would not be the same beds in the same wards that were empty all the time. If you run an acute service you have to have the capacity to cope with the unexpected and inevitably that will mean beds that lie empty a lot of the time." It was clear from the look on her face that she hadn't actually thought about things in that way. But it came to pass. The new Royal Infirmary was built with fewer beds and has struggled with over-demand ever sicne and all the crap problems like boarding. No matter how the managers like to tart it up patients who are boarded are getting a poorer service. |
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Re: It's Winter, so let's board some patients!
posted at 31/10/2012 3:06 PM GMT
on bmj.com
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Posts: 522
First: 6/9/2012 Last: 20/5/2013 |
Same everywhere. When I was a student, one day two infants were admitted to my teaching hospital in late november with mild bronchitis. When we wanted to contacted the parents the next day, they were nowhere to be found and apparently did not have a permanent address. The nurses were familiar with the situation, telling us they knew the family, which had a habit of leaving their youngest children in the hospital during winter, and that they would come for them in february. Ans so they did! Unthinkable nowadays with the DRG system, and not common 20 yrs ago, or so I hope.I also remember admitting a 93 year old gentleman to the paediatric ward because they had the only remaining bed. Parents complained... |
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Re: It's Winter, so let's board some patients!
posted at 31/10/2012 3:52 PM GMT
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
Steve - I was working in the old RIE whilst they were building the New RIE - I had exactly the same conversations, as I was the junior doc representative for the planning! Before I got into the new building, there was no doctors' mess set aside. I kicked up a fuss, they set aside space, then turned it into office space, I think. The old orthopaedic hospital closed, the eye hospital closed, and the old RIE closed - then the new RIE opened with about 250 fewer beds. And £9 a day parking. Genius. You might remember the winter ward in the old RIE? I ran it as an SHO in 2001. Ward 40, or 40 something, I think. Tucked away in some old buildings. I spent my days rewriting drug charts, and doing discharge summaries for other wards.... Good times. What were you up to back then? We probably met....
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Re: It's Winter, so let's board some patients!
posted at 31/10/2012 11:16 PM GMT
on bmj.com
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Posts: 61
First: 28/10/2012 Last: 19/2/2013 |
Boarding patients in other wards doesn't exist in my country ( Algeria) ; well , i find it quite interesting but it requires kind of agreement between the head services , which is not always possible . Is there a medical law in a matter of boarding patients ? or is it like an intern hospital law ? or is it only about agreement between medical chiefs ? When we don't have a bed , we let the patient at the emergency pavillion until a place is available . Some doctors forward the patient to another hospital when there's no vital risk - I don't recommend this attitude as we can't neglect a risk of complication on the way to another hospital . Thanks for your comments . mimi
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Re: It's Winter, so let's board some patients!
posted at 6/11/2012 7:22 PM GMT
on bmj.com
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Posts: 318
First: 27/10/2011 Last: 20/5/2013 |
Perhaps we need to shake off the administrative bunkum that an empty bed is a wasted bed? If there is seasonal fluctuation, then surely the beds numbers need to fluctuate accordingly? Perhaps the questions is better answered by asking what we need to do with beds when empty rather than what to do with patients when there are no beds? I also feel very strongly about streamlining care so that patients spend as little time as possible in hospital. Yes, they are not very good places in which to be, however, from a radiological perspective, I can't help but feel sometimes that referrers are looking for that negative imaging result so that the 'patient can be go home if normal'. Since when does an x-ray or scan relieve the presenting complaint? Grrrr!
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Re: It's Winter, so let's board some patients!
posted at 6/11/2012 10:36 PM GMT
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
Our difficulty is getting the other directorates within the hospital to talk to each other, and allow movement between the wards. A winter ward.... just a dream, I think.
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Forums » Open clinical » General clinical » It's Winter, so let's board some patients!
